Sharif Saleh, Kalmanovich Eran, Marcus Gil, Tsiporin Faina, Minha Sa'ar, Barkagan Michael, Love Itamar, Fuchs Shmuel, Zahavi Guy, Milman Anat
Division of Cardiovascular Medicine, Shamir Medical Center, Beer Yaakov 70300, Israel.
Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel.
J Clin Med. 2025 Jul 15;14(14):5005. doi: 10.3390/jcm14145005.
Pulmonary embolism (PE) increases right ventricular (RV) afterload, potentially leading to myocardial stress and electrocardiographic abnormalities. Although QTc prolongation has been suggested as a marker of RV dysfunction, its prevalence, clinical significance, and prognostic value in acute PE remain poorly defined. The objective of this study is to evaluate the prevalence and clinical implications of QTc prolongation in patients with intermediate-high and high-risk acute PE. : We retrospectively analyzed 95 consecutive patients admitted with intermediate-high or high-risk PE between September 2021 and December 2023. QTc prolongation was defined as ≥470 ms in males and ≥480 ms in females. Clinical, imaging, and laboratory data were compared between patients with normal and prolonged QTc intervals. QTc was assessed at admission, after treatment, and prior to discharge. QTc prolongation was observed in 28.4% of patients at presentation. This group had significantly higher lactate levels (2.3 vs. 1.8 mmol/L, = 0.03) and a non-significant trend toward elevated troponin and lower oxygen saturation. No differences were observed in echocardiographic or CT-based RV dysfunction parameters. QTc values normalized by discharge irrespective of treatment modality. There was no association between QTc prolongation and in-hospital or long-term mortality. A trend toward more aspiration thrombectomy was noted in the prolonged QTc group (29.6% vs. 11.8%, = 0.06). QTc prolongation is common in acute intermediate-high and high-risk PE and may reflect transient myocardial stress. While not predictive of clinical outcomes, it should be considered in the differential diagnosis of QTc prolongation in patients presenting with dyspnea and chest pain.
肺栓塞（PE）会增加右心室（RV）后负荷，可能导致心肌应激和心电图异常。尽管QTc延长被认为是右心室功能障碍的一个标志物，但其在急性PE中的发生率、临床意义和预后价值仍不明确。本研究的目的是评估中高危和高危急性PE患者中QTc延长的发生率及其临床意义。我们回顾性分析了2021年9月至2023年12月期间连续收治的95例中高危或高危PE患者。QTc延长定义为男性≥470毫秒，女性≥480毫秒。比较了QTc间期正常和延长的患者的临床、影像学和实验室数据。在入院时、治疗后和出院前评估QTc。就诊时28.4%的患者观察到QTc延长。该组乳酸水平显著更高（2.3 vs. 1.8 mmol/L，P = 0.03），肌钙蛋白升高和氧饱和度降低有非显著性趋势。在基于超声心动图或CT的右心室功能障碍参数方面未观察到差异。无论治疗方式如何，QTc值在出院时均恢复正常。QTc延长与住院或长期死亡率之间无关联。QTc延长组行抽吸血栓切除术的趋势更明显（29.6% vs. 11.8%，P = 0.06）。QTc延长在急性中高危和高危PE中很常见，可能反映短暂的心肌应激。虽然不能预测临床结局，但在对出现呼吸困难和胸痛的患者进行QTc延长的鉴别诊断时应予以考虑。
